Meta-analysis of efficacy of quinine for treatment of nocturnal leg cramps in elderly people

BMJ 1995;310:13-17 (7 January)

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Meta-analysis of efficacy of quinine for treatment of nocturnal leg cramps in elderly people

Malcolm Man-Son-Hing, assistant professor of medicine,^a George Wells, associate professor ^b

^a Division of Geriatric Medicine, University of Ottawa, Geriatric Assessment Unit, Ottawa Civic Hospital, Ottawa, Ontario, Canada K1Y 4E9, ^b Department of Medicine, University of Ottawa, Clinical Epidemiology Unit, Ottawa Civic Hospital, Ottawa, Ontario, Canada

Correspondence to: Dr Man-Son-Hing.

Abstract

Objective: To assess quantitatively the efficacy of quinine(as quinine sulphate) compared with placebo in the treatmentof nocturnal leg cramps.
Design: A meta-analysis of six randomised, double blind, crossovertrials.
Setting: Randomised trials that were available as of April 1994.
Subjects: A total of 107 general ambulatory patients who sufferedfrom regular nocturnal leg cramps from six clinical trials.
Results: Data from individual patients were used to calculatepoint estimates and 95% confidence intervals for each of theoutcome measures reported by these studies. Treatment with quinineresulted in a significant reduction in the number of crampsfor a four week period compared with placebo (8.83 fewer cramps;95% confidence interval 4.16 to 13.49). Treatment with quininereduced the number of nights with cramps by 27.4% (24.0% to30.8%) compared with placebo. Treatment did not produce a significantchange in the severity or duration of individual nocturnal legcramps. Side effects were uncommon.
Conclusions: The results indicate that quinine can prevent nocturnalleg cramps in general ambulatory populations. Given the possibleserious side effects of treatment with quinine, the benefitsand risks in patients taking this drug should be closely monitored.

Key messages

Key messages
The results of this meta-analysis show that quinine sulphate is more effective than placebo in reducing the number of cramps experienced by patients
This analysis also suggests that dosing is cumulative, therefore a trial of at least four weeks of quinine may be necessary to show a beneficial effect
Quinine should be taken on a regular as opposed to as needed basis as it could not be shown definitively to reduce the severity or duration of an individual cramp

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